Two very interesting articles have been published in the last 24 hours – both of which have prompted me to reflect on the culture of local government.
The Association of Directors of Adult Social Services (ADASS) has published anonymous feedback from its members on coping with the winter crisis. Two findings jumped out:
- More than 50% of councils are taking ‘exceptional measures’ – doing something they recognise is not ideal in terms of the care they are providing to people (restricting care, using poorer performing providers) in order to prioritise ‘life sustaining care’.
- A ‘small but significant’ number of councils (13%) admitted deciding to provide just ‘life and limb care’ at some point – only giving the most urgent and critical support.
At the same time, a leading and respected council Chief Executive, Owen Mapley of Hertfordshire County Council, tells The MJ that now is the time to consider having a public risk rating for social care – similar to the NHS Operational Pressures Escalation Levels (OPEL) rating. This would be a big cultural change.
The decisions that social services have made typically have not been widely communicated or even formally signed off – they have been justified as crisis response. I was struck by how different the culture in the NHS and local government is.
Each council has to make multiple complex decisions across their wide range of statutory and discretionary services, always with an eye to their legal responsibility to have a balanced budget. Some of this is public, for example through long budget agreement public consultation and sign off meetings. Some of it, however, is managed under the radar, for example the 300,000 people on social care waiting lists that is essentially a way of rationing. Whereas the NHS is much more able to directly respond to central policy and crisis response directives.
There are two big changes happening across health and care present an opportunity for change:
- There is real momentum in health and care integration which is blurring boundaries
- The pandemic has led to a different relationship with the public where there is a much greater acceptance of adapting to crises
So, is now the moment to seize the opportunity to fundamentally change the relationship between councils and citizens? A step change in local government’s ability to be honest and open could really shift the dial for social care. The question is, could this form part of a blueprint for a new social contract?